目的探讨丁苯酞对大面积脑梗死预后的影响。方法选取201 1年2月~2013年12月期间,在哈励逊国际和平医院神经内科住院的大面积脑梗死患者92例作为研究对象,采用对照研究。将患者随机分为对照组(n=46)和治疗组(n=46)。对照组给予依达拉奉...目的探讨丁苯酞对大面积脑梗死预后的影响。方法选取201 1年2月~2013年12月期间,在哈励逊国际和平医院神经内科住院的大面积脑梗死患者92例作为研究对象,采用对照研究。将患者随机分为对照组(n=46)和治疗组(n=46)。对照组给予依达拉奉注射液静脉滴注,治疗组在此基础上给予丁苯酞胶囊联合治疗。2组患者均持续给药,疗程为2周。利用神经功能缺损程度评分(national institute of health stroke scale,NIHSS)^([1])评定2组患者症状改善情况,利用磁敏感成像技术(susceptibility-weighted imaging,SWI)侧支血管分级标准评估丁苯酞对缺血梗死区侧支循环的影响,并对结果加以分析。结果对照组与治疗组的症状与体征均有一定程度的改善,治疗组的改善程度明显高于对照纽,差异有统计学意义(P<0.05);治疗纽的神经功能缺损程度评分情况优于对照组,差异有统计学意义(P<0.05);对照组与治疗组SWI侧支血管显示分级均有提高,但治疗组患者提高例数显著多于对照组,差异有统计学意义(P<0.05);治疗过程中2组患者均未出现明显不良反应。结论丁苯酞治疗大面积脑梗死预后效果较好,可有效改善神经功能缺损,促进缺血梗死区侧枝循环重建。展开更多
脑微出血(cerebral microbleeds,CMBs)属于脑小血管病(cerebral small vessel disease,CSVD)的范畴,不同类型CSVD的发病机制、危险因素及其临床意义是不同的,诸多研究显示,CMBs已成为影响卒中后出血转化、预后和复发、造成认知障碍以及...脑微出血(cerebral microbleeds,CMBs)属于脑小血管病(cerebral small vessel disease,CSVD)的范畴,不同类型CSVD的发病机制、危险因素及其临床意义是不同的,诸多研究显示,CMBs已成为影响卒中后出血转化、预后和复发、造成认知障碍以及年龄相关能力丧失的重要危险因素。CMBs与脑出血联系紧密,可作为某些脑血管病的辅助诊断和出血预测指标,对其进行深入细致的研究,有助于揭示CSVD的发生机制,对制定溶栓、抗凝、抗血小板等治疗方案具有重要的指导意义。因此,探讨CMBs发病机制(包括基因遗传学、组织病理学)、早期预警及干预的手段是解决上述医学难题的关键。本文重点对CMBs的定义及存在的争议、发病机制、流行病学、影像学表现及其临床意义进行综述分析并提出研究展望,以期为CMBs的相关研究提供启示。展开更多
Objective： To provide a comprehensive and latest overview of susceptibility-weighted imaging （SWI） in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical ...Objective： To provide a comprehensive and latest overview of susceptibility-weighted imaging （SWI） in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical value of SWI on identifying stroke patients suitable for thrombolytic therapy and possible benefits and risks followed. Data Sources： Literatures referred to this review were collected from PubMed, Medline, and EMBASE published till May 2017, using the search terms including susceptibility-weighted imaging, gradient-echo, T2＊, thrombolysis, recombinant tissue plasminogen activator （rt-PA）, thrombolytic therapy, and stroke. Study Selection： Papers in EngLish or with available English abstracts were considered, with no limitation of study design. References were also identified from the bibliographies of identified articles and the authors＇ files. Results： SW1 is of guiding significance for thrombolytic therapy in stroke patients, it can predict the location and length of thrombus and ischemic penumbra. It is worthy of noting that susceptibility vessel sign （SVS） on SWI can be used to predict recanalization after thrombolytic therapy and whether it is better to implement endovascular thrombolectonqy in combination or alone. SW1 is sensitive in detecting cerebral microbleed （CMB）, and CMB might not be a contraindication for thrombolytic therapy, yet CMBs in multiple loci could possibly be related to intracranial hemorrhage （ICH） after thrombolysis. SVS and CMB on SWI sequence are of instructive value in performing antiplatelet therapy after thrombolytic therapy. Cerebral venous change on SWI is related to lower recanalization rate and poor outcome after thrombolysis. Conclusions： It seems that SWI can be applied to guide individualized thrombolytic therapies and assist clinicians in making better decisions by weighing benefits and risks. However, there still exist controversies about the relationship between signs on SWI and thrombolytic therapy.展开更多
目的探讨病变内磁敏感性效应(SusE)与磁共振动态增强扫描(DCE4VIRI)定量参数在外周带前列腺癌和前列腺炎鉴别诊断中的价值。方法回顾性分析65例行3.0 T MR磁敏感成像(SWI)和DCE扫描并经穿刺活检病理证实的前列腺外周带T_2信号减低的初...目的探讨病变内磁敏感性效应(SusE)与磁共振动态增强扫描(DCE4VIRI)定量参数在外周带前列腺癌和前列腺炎鉴别诊断中的价值。方法回顾性分析65例行3.0 T MR磁敏感成像(SWI)和DCE扫描并经穿刺活检病理证实的前列腺外周带T_2信号减低的初诊患者,其中前列腺癌32例前列腺炎33例。以4分制评估外周带T_2低信号灶及邻近外周带SusE,并测量相应层面病灶区及正常前列腺外周带DCE-MRI定量参数转运常数(K^(trans))、血管外细胞外间隙体积百分数(V_e)及速率常数(K_(ep))。通过Spearman分析比较SusE与K^(trans)、K_(ep)、V_e的相关性。通过Mann-Whitney test检验比较前列腺癌和前列腺炎病灶SusE差异。单因素方差分析比较K^(trans)、K_(ep)、V_e在前列腺癌、前列腺炎和正常前列腺外周带间的差异。ROC曲线比较SWI和DCE的诊断准确性。结果 SusE与K^(trans)、K_(ep)呈正线性相关(r值分别为0.419、0.219,P值分别为<0.001、0.034),与V_e无相关性(r=0.088,P=0.402)。在外周带前列腺癌和前列腺炎中SusE、K^(trans)、K_(ep)差异均有统计学意义(P<0.05),V_e差异无统计学意义(P>0.05)。以0分作为界值点,SusE鉴别前列腺癌和前列腺炎的敏感性、特异性、ROC曲线下面积分别为73.68%、65.62%、0.767;以0.103 min^(-1)作为界值,K^(trans)鉴别前列腺癌和前列腺炎的敏感性、特异性、ROC曲线下面积分别为78.12%、84.21%、0.753。以0.431 min^(-1)作为界值,K_(ep)鉴别前列腺癌和前列腺炎的敏感性、特异性、ROC曲线下面积分别为78.95%、59.38%、0.767。结论 SWI半定量参数SusE与动态增强定量参数具有一定的相关性,可作为DCE-MRI的一种补充方法。病灶内微出血灶可以作为辅助鉴别诊断前列腺癌与前列腺炎的证据。展开更多
AIM:To review the literature on the assessment of venous vessels to estimate the penumbra on T2*w imaging and susceptibility-weighted imaging (SWI). METHODS:Literature that reported on the assessment of penumbra by T2...AIM:To review the literature on the assessment of venous vessels to estimate the penumbra on T2*w imaging and susceptibility-weighted imaging (SWI). METHODS:Literature that reported on the assessment of penumbra by T2*w imaging or SWI and used a validation method was included. PubMed and relevant stroke and magnetic resonance imaging (MRI) related conference abstracts were searched. Abstracts that had overlapping content with full text articles were excluded. The retrieved literature was scanned for further relevant references. Only clinical literature published in English was considered, patients with Moya-Moya syndrome were disregarded. Data is given as cumulative absolute and relative values, ranges are given where appropriate. RESULTS:Forty-three publications including 1145 patients could be identified. T2*w imaging was used in 16 publications (627 patients), SWI in 26 publications (453 patients). Only one publication used both (65 patients). The cumulative presence of hypointense vessel sign was 54% (range 32%-100%) for T2* (668 patients) and 81% (range 34%-100%) for SWI (334 patients). There was rare mentioning of interrater agreement (6 publications, 210 patients) and reliability (1 publication, 20 patients) but the numbers reported ranged from good to excellent. In most publications (n = 22) perfusion MRI was used as a validation method (617 patients). More patients were scanned in the subacute than in the acute phase (596 patients vs 320 patients). Clinical outcome was reported in 13 publications (521 patients) but was not consistent. CONCLUSION:The low presence of vessels signs on T2*w imaging makes SWI much more promising. More research is needed to obtain formal validation and quantification.展开更多
文摘目的探讨丁苯酞对大面积脑梗死预后的影响。方法选取201 1年2月~2013年12月期间,在哈励逊国际和平医院神经内科住院的大面积脑梗死患者92例作为研究对象,采用对照研究。将患者随机分为对照组(n=46)和治疗组(n=46)。对照组给予依达拉奉注射液静脉滴注,治疗组在此基础上给予丁苯酞胶囊联合治疗。2组患者均持续给药,疗程为2周。利用神经功能缺损程度评分(national institute of health stroke scale,NIHSS)^([1])评定2组患者症状改善情况,利用磁敏感成像技术(susceptibility-weighted imaging,SWI)侧支血管分级标准评估丁苯酞对缺血梗死区侧支循环的影响,并对结果加以分析。结果对照组与治疗组的症状与体征均有一定程度的改善,治疗组的改善程度明显高于对照纽,差异有统计学意义(P<0.05);治疗纽的神经功能缺损程度评分情况优于对照组,差异有统计学意义(P<0.05);对照组与治疗组SWI侧支血管显示分级均有提高,但治疗组患者提高例数显著多于对照组,差异有统计学意义(P<0.05);治疗过程中2组患者均未出现明显不良反应。结论丁苯酞治疗大面积脑梗死预后效果较好,可有效改善神经功能缺损,促进缺血梗死区侧枝循环重建。
文摘脑微出血(cerebral microbleeds,CMBs)属于脑小血管病(cerebral small vessel disease,CSVD)的范畴,不同类型CSVD的发病机制、危险因素及其临床意义是不同的,诸多研究显示,CMBs已成为影响卒中后出血转化、预后和复发、造成认知障碍以及年龄相关能力丧失的重要危险因素。CMBs与脑出血联系紧密,可作为某些脑血管病的辅助诊断和出血预测指标,对其进行深入细致的研究,有助于揭示CSVD的发生机制,对制定溶栓、抗凝、抗血小板等治疗方案具有重要的指导意义。因此,探讨CMBs发病机制(包括基因遗传学、组织病理学)、早期预警及干预的手段是解决上述医学难题的关键。本文重点对CMBs的定义及存在的争议、发病机制、流行病学、影像学表现及其临床意义进行综述分析并提出研究展望,以期为CMBs的相关研究提供启示。
文摘Objective： To provide a comprehensive and latest overview of susceptibility-weighted imaging （SWI） in the application of thrombolysis in acute ischemic stroke, and to update the decision-making effect and clinical value of SWI on identifying stroke patients suitable for thrombolytic therapy and possible benefits and risks followed. Data Sources： Literatures referred to this review were collected from PubMed, Medline, and EMBASE published till May 2017, using the search terms including susceptibility-weighted imaging, gradient-echo, T2＊, thrombolysis, recombinant tissue plasminogen activator （rt-PA）, thrombolytic therapy, and stroke. Study Selection： Papers in EngLish or with available English abstracts were considered, with no limitation of study design. References were also identified from the bibliographies of identified articles and the authors＇ files. Results： SW1 is of guiding significance for thrombolytic therapy in stroke patients, it can predict the location and length of thrombus and ischemic penumbra. It is worthy of noting that susceptibility vessel sign （SVS） on SWI can be used to predict recanalization after thrombolytic therapy and whether it is better to implement endovascular thrombolectonqy in combination or alone. SW1 is sensitive in detecting cerebral microbleed （CMB）, and CMB might not be a contraindication for thrombolytic therapy, yet CMBs in multiple loci could possibly be related to intracranial hemorrhage （ICH） after thrombolysis. SVS and CMB on SWI sequence are of instructive value in performing antiplatelet therapy after thrombolytic therapy. Cerebral venous change on SWI is related to lower recanalization rate and poor outcome after thrombolysis. Conclusions： It seems that SWI can be applied to guide individualized thrombolytic therapies and assist clinicians in making better decisions by weighing benefits and risks. However, there still exist controversies about the relationship between signs on SWI and thrombolytic therapy.
文摘AIM:To review the literature on the assessment of venous vessels to estimate the penumbra on T2*w imaging and susceptibility-weighted imaging (SWI). METHODS:Literature that reported on the assessment of penumbra by T2*w imaging or SWI and used a validation method was included. PubMed and relevant stroke and magnetic resonance imaging (MRI) related conference abstracts were searched. Abstracts that had overlapping content with full text articles were excluded. The retrieved literature was scanned for further relevant references. Only clinical literature published in English was considered, patients with Moya-Moya syndrome were disregarded. Data is given as cumulative absolute and relative values, ranges are given where appropriate. RESULTS:Forty-three publications including 1145 patients could be identified. T2*w imaging was used in 16 publications (627 patients), SWI in 26 publications (453 patients). Only one publication used both (65 patients). The cumulative presence of hypointense vessel sign was 54% (range 32%-100%) for T2* (668 patients) and 81% (range 34%-100%) for SWI (334 patients). There was rare mentioning of interrater agreement (6 publications, 210 patients) and reliability (1 publication, 20 patients) but the numbers reported ranged from good to excellent. In most publications (n = 22) perfusion MRI was used as a validation method (617 patients). More patients were scanned in the subacute than in the acute phase (596 patients vs 320 patients). Clinical outcome was reported in 13 publications (521 patients) but was not consistent. CONCLUSION:The low presence of vessels signs on T2*w imaging makes SWI much more promising. More research is needed to obtain formal validation and quantification.
